- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,365.16 / $7,585.78
| Facility | | $602.56 | $4,365.16 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,348.96
| Facility | | $1,318.26 | $1,318.26 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $1,047.13
| Professional | | $741.31 | $741.31 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $588.84 / $977.24
| Facility | | $436.52 | $588.84 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,467.37 / $6,606.93
| Facility | | $1,202.26 | $3,467.37 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $28,840.32
| Facility | | $4,786.30 | $4,786.30 | $28,840.32 |